| Entity Name: | THE FLORIDA PAIN MANAGEMENT CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
THE FLORIDA PAIN MANAGEMENT CENTER, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 04 Jun 1987 (38 years ago) |
| Date of dissolution: | 27 Sep 2024 (7 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (7 months ago) |
| Document Number: | J75833 |
| FEI/EIN Number |
593006597
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 111 WATERMAN AVENUE, MT. DORA, FL, 32757 |
| Mail Address: | 111 WATERMAN AVENUE, MT. DORA, FL, 32757 |
| ZIP code: | 32757 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811967250 | 2006-01-26 | 2013-12-13 | 111 WATERMAN AVE, MOUNT DORA, FL, 327579541, US | 111 WATERMAN AVE, MOUNT DORA, FL, 327579541, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 352-735-3313 |
| Fax | 3527353711 |
Authorized person
| Name | STACY J. BERCKES |
| Role | PRESIDENT |
| Phone | 3527353313 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | No |
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | Yes |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0053506100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BURTON BUSH RICHARD | Agent | 3375 Capital Cir NE, TALLAHASSEE, FL, 323083778 |
| BERCKES, STACY J. | Secretary | 38440 TIMBERLANE DRIVE, UMATILLA, FL |
| BERCKES, STACY J. | President | 38440 TIMBERLANE DRIVE, UMATILLA, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-21 | 3375 Capital Cir NE, SUITE 300, Bldg C200, TALLAHASSEE, FL 32308-3778 | - |
| REGISTERED AGENT NAME CHANGED | 2003-01-22 | BURTON BUSH, RICHARD | - |
| CHANGE OF PRINCIPAL ADDRESS | 1994-12-05 | 111 WATERMAN AVENUE, MT. DORA, FL 32757 | - |
| CHANGE OF MAILING ADDRESS | 1994-12-05 | 111 WATERMAN AVENUE, MT. DORA, FL 32757 | - |
| CORPORATE MERGER | 1993-06-15 | - | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. CORPORATE MERGER NUMBER 900000001449 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-01-29 |
| ANNUAL REPORT | 2018-01-17 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-27 |
| ANNUAL REPORT | 2015-01-16 |
| ANNUAL REPORT | 2014-02-01 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 9626317007 | 2020-04-09 | 0491 | PPP | 111 WATERMAN AVE, MOUNT DORA, FL, 32757-9541 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 8976168502 | 2021-03-10 | 0491 | PPS | 111 Waterman Ave, Mount Dora, FL, 32757-9541 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 May 2025
Sources: Florida Department of State
